Registration

Enrollment is for the 2017-2018 Dance Season. There is a $25.00 Annual Family Registration Fee. There are discounts for additional classes and also for siblings.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info*

Contact #1

Contact #1 First Name*

Last Name *

Relationship*

How Can We Contact You?

Home Phone

Work #

Cell #

Portal Access (your email is your login)

Email*(Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Relationship

How can we contact you?

Home Phone

Work #

Cell #

Email(Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*
(format=mm/dd/yyyy)

Additional Info

Disabilites

Special Needs

Allergies

Please select class(s) for your child. There is a monthly tuition discount when enrolled in two or more classes. There is also discounts for more than one family member. Your child may be transferred to a different class based on their experience & ability.

Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #2
(Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*
(format=mm/dd/yyyy)

Additional Info

Disabilites

Special Needs

Allergies

Please select class(s) for your child. There is a monthly tuition discount when enrolled in two or more classes. There is also discounts for more than one family member. Your child may be transferred to a different class based on their experience & ability.

Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #3
(Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*
(format=mm/dd/yyyy)

Additional Info

Disabilites

Special Needs

Allergies

Please select class(s) for your child. There is a monthly tuition discount when enrolled in two or more classes. There is also discounts for more than one family member. Your child may be transferred to a different class based on their experience & ability.

Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #4
(Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*
(format=mm/dd/yyyy)

Additional Info

Disabilites

Special Needs

Allergies

Please select class(s) for your child. There is a monthly tuition discount when enrolled in two or more classes. There is also discounts for more than one family member. Your child may be transferred to a different class based on their experience & ability.

Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #5
(Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*
(format=mm/dd/yyyy)

Additional Info

Disabilites

Special Needs

Allergies

Please select class(s) for your child. There is a monthly tuition discount when enrolled in two or more classes. There is also discounts for more than one family member. Your child may be transferred to a different class based on their experience & ability.

Required Policies and Agreements

Payment Information

Tuition is due by the first of each month. If accounts are paid after the tenth of the month, there will be a $15.00 late fee applied to the account balance. There is a $25.00 returned check charge for any checks returned by the bank.

I've read the above and agree.

Release of Liability

Liability Waiver and Acknowledgment of Risk: READ AND SIGN BELOW

REGISTRATION IS INCOMPLETE WITHOUT SIGNATURE AND MUST BE COMPLETED BEFORE CLASS

I understand and agree that in participating in any dance class, workshop, rehearsal or performance, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of Contempo Dance Center's classes, rehearsals, performances, or activities. I also exempt, release, and indemnify Contempo Dance Center, its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by Contempo Dance Center. I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold Contempo Dance Center, its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights.

Permission is granted to Contempo Dance Center to use photographs of students for publicity purposes.

I have read, understood and agree to be bound by the above statement (please print your name, sign & date):

I've read the above and agree.

Medical Emergency

The undersigned gives permission to Contempo Dance Center, its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian.

I've read the above and agree.

Signature Text

As the legal parent or guardian, I release and hold harmless Contempo Dance Center, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Contempo Dance Center, its owners and operators or in route to or from any of said premises.